Preventing Mediastinitis with Mupirocin Keli S Holley RN BSN, Bonnie Sanderson PhD, RN Auburn University School of Nursing . What We Learned.
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Keli S Holley RN BSN, Bonnie Sanderson PhD, RN
Auburn University School of Nursing
What We Learned
Mediastinitis is a potentially life threatening infection that can occur in patients receiving midline sternal incisions from open heart surgery. The aim was to determine if treating patients with intranasal topical mupirocin before undergoing open heart surgery will prevent methicillin resistant staphylococcus aureus (MRSA) related surgical site infections such as mediastinitis.
A clinical practice guideline suggested using mupirocin preoperatively to prevent infections giving it a Class I, Level A Recommendation (Engelman et al., 2007).
A Cochrane systematic review suggest the use of mupirocin ointment results in a statistically significant reduction in S. aureus infections including mediastinitis (van Rijen et al., 2008).
Treated with Pre-Op Bactroban Compared to the Previous Month Where Patients Were Not Treated with Bactroban
The main outcome for my small test of change is to significantly lower to zero the incidences of MRSA infections post open heart surgery. However, with such a small sample size, significance may not be found. Perhaps with one year’s worth of surveillance of this evidence based project and better resources, such as the PCR essay to screen for MRSA, the project would be more significant.
Thank you to East Alabama Medical Center
Engelman, R., Shahian, D., Shemin, R., Sloane, G. T., Bratzler, D., Edwards, F., . . . Bridges, C. (2007). The society of thoracic surgeons practice guideline series: Antibiotic prophylaxis in cardiac surgery, part II: Antibiotic choice. The Society of Thoracic Surgeons Workforce on Evidence Based Medicine. 83(4), 1569-1576. Retrieved from: http://www.sts.org/resources-publications/clinical-practice-credentialing-guidelines/antibiotic-guidelines
van Rijen, M., Bonten, M., Wenzel, R., Kluytmans, J. (2008). Mupirocin ointment for preventing staphylococcus aureus infections in nasal carriers. Cochrane Database of Systematic Reviews 2008, Issue 4. Art.No:CD006216.
The administration of mupirocin (Bactroban) intranasally twice a day for five days starting the day before their surgery showed an elimination of the complication of MRSA for cardiac surgery patients. Patients were routinely followed for 30 days to evaluate for infections, and data was collected and analyzed for significant improvements in surgical site infection rates.